Long-Term Clinical Outcomes in Patients with Chronic Rhinosinusitis with Nasal Polyps Associated with Expanded Types of Endoscopic Sinus Surgery.

(1) Background: Surgical criteria for chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved. This study addresses these discrepancies by comparing the clinical outcomes of expanded-functional endoscopic sinus surgeries (E-FESS) with more-limited FESS (L-FESS). (2) Methods: A database was analyzed retrospectively to compare surgical outcomes in CRSwNP patients who underwent E-FESS versus those subjected to L-FESS. Quality of life, endoscopic and radiological outcomes were compared at the baseline and two years after surgery. The clinical status of the responder was defined when a minimal clinically important difference of 12 points in SNOT-22 change was achieved. (3) Results: A total of 274 patients met the inclusion criteria and were analyzed; 111 underwent E-FESS and 163 were subjected to L-FESS. Both groups exhibited significant clinical improvements, although a greater magnitude of change in SNOT-22 (14.8 ± 4.8, p = 0.002) was shown after E-FESS. Higher significant improvements for endoscopic and radiological scores and lower surgical revision rates were also noted in the E-FESS group. (4) Conclusions: E-FESS provides better clinical outcomes and reduced revision surgery rates when compared to L-FESS in CRSwNP patients two years after surgery, irrespective of any comorbidity. Further randomized prospective studies are needed to comprehensively contrast these results.

Improved quality of life in patients with chronic rhinosinusitis with nasal polyps associated with expanded types of endoscopic sinus surgery: A 2-year retrospective study.

KEY POINTS: Expanded types of functional endoscopic sinus surgery (FESS) significantly improve quality of life and reduce revision surgeries rates, supporting their early application for moderate-to-severe cases. Minimal clinically important difference may play as a crucial role in defining surgical treatment response (i.e., responder and super-responder conditions). Expanded FESS benefits patients with chronic rhinosinusitis with nasal polyps but more data are required to have a clearer understanding of its uses due to varied approaches and reported outcomes in the literature.

Endoscopic Extended Sinus Surgery for Patients with Severe Chronic Rhinosinusitis with Nasal Polyps, the Choice of Mucoplasty: A Systematic Review.

PURPOSE OF REVIEW: The advances in the knowledge of the molecular basis of the inflammatory response in chronic rhinosinusitis with nasal polyps (CRSwNP) have led the management of these patients towards personalized and precision medicine. Surgery has been positioned as a suitable alternative in patients who do not achieve control with appropriate medical treatment, but polypoid recurrences remain a constraint. The emergence of new surgical approaches based on patient phenotyping and the poor disease control associated with type 2 inflammatory phenotype makes it necessary to review the role of personalized and precision surgery in managing the disease. RECENT FINDINGS: Surgical approaches based on wide resection of bony sinus structures and the treatment of mucosa lining the sinonasal cavity have been analyzed and compared with other techniques and seem to offer more favorable surgical outcomes and improved quality of life (QoL), in addition to lower relapse rates. The innovations with new complementary surgical techniques, such as reboot surgery adding an extended autologous mucosal graft from the nasal floor (mucoplasty), may benefit endoscopic and QoL outcomes in the most severe CRSwNP patients with type 2 phenotype. Using bilateral endonasal mucoplasty as a complementary technique to reboot surgery is a suitable technical choice that has improved short- and medium-term QoL and endoscopic outcomes for patients with severe CRSwNP. These results are likely due to a combination of the extension of reboot and the inherent inflammatory and healing properties of mucoplasty. We propose this technique as a valuable surgical resource, although more robust clinical studies are needed to evaluate its long-term benefits comprehensively.

Internal workload in elite female football players during the whole in-season: starters vs non-starters.

The aim of this study was to quantify weekly internal workload across the in-season and compare the workload variables between starter and non-starter Spanish female first league (Liga Iberdrola) football players. Twenty-six participants belonging to the same team (age, height, and mass: 25.4 ± 6.1 years, 167.4 ± 4.8 cm and 57.96 ± 6.28 kg, respectively) participated in this study. Training loads (TL) and match loads (ML) were assessed through breath-cardiovascular (RPEbreath), leg-musculature (RPEleg) and cognitive (RPEcog) rating of perceived exertion (RPE0-10) for each training session and match during the in-season phase (35 weeks). Session-RPE (sRPE) was calculated by multiplying each RPE value by session duration (minutes). From these, total weekly TL (weekly TL+ML), weekly TL, weekly ML, chronic workload, acute:chronic workload ratio, training monotony, and training strain were calculated. Linear mixed models were used to assess differences for each dependent variable, with playing time (starter vs non-starter players) used as a fixed factor, and athlete, week, and team as random factors. The results showed that total weekly TL (d = 1.23-2.04), weekly ML (d = 4.65-5.31), training monotony (d = 0.48-1.66) and training strain (d = 0.24-1.82) for RPEbreath, RPEleg and RPEcog were higher for starters in comparison with non-starters (p = 0.01). Coaches involved in elite female football should consider implementing differential sRPE monitoring strategies to optimize the weekly load distribution for starters and non-starters and to introduce compensatory strategies to equalise players' total weekly load.

Omalizumab Treatment in Uncontrolled Asthma and CRSwNP Patients, with Previous Endoscopic Sinus Surgery, to Improve Quality of Life and Endoscopic Outcomes: a Two-Year Real-Life Study.

PURPOSE OF REVIEW: Despite molecular underlying advances, limited and divergent data on monoclonal antibodies (mAb) therapy in chronic rhinosinusitis with nasal polyps (CRSwNP) make further analysis necessary. The objective of this study is to evaluate the effect of omalizumab as an adjunct to endoscopic sinus surgery (ESS) on the treatment of CRSwNP under real-life conditions. RECENT FINDINGS: Since the introduction of omalizumab, as the first biologic agent for the treatment of diseases such as severe allergic asthma, different studies have demonstrated an effect of omalizumab on CRSwNP, with significant improvements in sinonasal symptoms and endoscopic scores. The high efficacy derived from mAb therapy and the need for ESS prior to mAb recommended by guidelines, has led to compare both therapeutic alternatives, finding discrepancies in their effect on quality of life (QoL) and complementary tests outcomes. Patients with moderate-to-severe asthma with clinical criteria for omalizumab indication, and coexistent CRSwNP disease, were selected for a non-randomized interventional retrospective study into four treatment subgroups. Measures were analyzed and compared between groups and over time at the baseline, 16 weeks and 1 and 2 years after treatment. Omalizumab treatment in patients with previous ESS exhibited an earlier and more pronounced improvement in QoL, symptoms scale and endoscopic findings (nasal polyp score and the bilateral modified Lund-Kennedy) as early from week 16, which improvement persisted for 2 years. A greater mean improvement of 33.4 ± 6.5 (95% CI: 20.3-46.4; p < 0.001) points in sinonasal outcome test 22 (SNOT-22) was associated with ESS at week 16, against omalizumab effect (17.8 ± 7.6 [95% CI: 2.6-33.0]; p = 0.023). At year 2, an improvement in SNOT-22 of 62.6 ± 8.9 (95% CI: 48.4-84.1; p < 0.001) points was exclusively associated with omalizumab. Clinical evidence of the effect of omalizumab added to ESS treatment is provided in this study in the short- and long-term.

A Systematic Review and Meta-Analysis of the Differences in Mean Propulsive Velocity between Men and Women in Different Exercises.

The purpose of this paper was to conduct a systematic review and meta-analysis of studies examining the differences in the mean propulsive velocities between men and women in the different exercises studied (squat, bench press, inclined bench press and military press). Quality Assessment and Validity Tool for Correlational Studies was used to assess the methodological quality of the included studies. Six studies of good and excellent methodological quality were included. Our meta-analysis compared men and women at the three most significant loads of the force-velocity profile (30, 70 and 90% of 1RM). A total of six studies were included in the systematic review, with a total sample of 249 participants (136 men and 113 women). The results of the main meta-analysis indicated that the mean propulsive velocity is lower in women than men in 30% of 1RM (ES = 1.30 ± 0.30; CI: 0.99-1.60; p < 0.001) and 70% of 1RM (ES = 0.92 ± 0.29; CI: 0.63, 1.21; p < 0.001). In contrast, for the 90% of the 1RM (ES = 0.27 ± 0.27; CI: 0.00, 0.55), we did not find significant differences (p = 0.05). Our results support the notion that prescription of the training load through the same velocity could cause women to receive different stimuli than men.

Effects of Resistance Priming Exercise on Within-day Jumping Performance and its Relationship with Strength Level.

This study aimed to identify the effects of same-day resistance priming exercise on countermovement jump parameters and subjective readiness, and to identify whether baseline strength level influenced these outcomes. Fourteen participants performed two separate conditions (Priming [2 sets high-load parallel squats with a 20% velocity loss cut-off] and Control) in a randomized, counterbalanced crossover design. Countermovement jump was assessed at pre, post and 6 h while readiness was assessed at pre and at 6 h only. All countermovement jump force-time metrics were similar between conditions (p>0.05), but different individual responses were noted 6 h after priming. Jump height was increased for 4/14, decreased for another 4/14, and maintained for 6/14 participants at 6 h. Higher perceived physical performance capability (p<0.001) and activation balance (p=0.005) were observed after priming only. Positive relationships were observed between strength and the percentage change in jump height (r=0.47-0.50; p=0.033-0.042), concentric peak velocity (r=0.48-0.51; p=0.030-0.041) and impulse (r=0.47; p=0.030-0.045) at post and 6 h after priming exercise. These findings suggest that velocity-based high-load low-volume priming exercise has potential to positively impact jump performance and subjective readiness later that day in certain individuals. Participant absolute strength level may influence this response but should be confirmed in subsequent studies.

Time Course of Jump Recovery and Performance After Velocity-Based Priming and Concurrent Caffeine Intake.

Purpose: Morning priming exercise and caffeine intake have been previously suggested as an effective strategy to increase within-day performance and readiness. However, the concurrent effect of both strategies is unknown. The present research aimed to map the within-day time course of recovery and performance of countermovement jump (CMJ) outcomes, kinetics, and strategy and readiness after priming alone and in combination with caffeine. Methods: Eleven participants performed a control, a priming exercise (Priming) and a priming with concurrent caffeine intake (PrimingCaf) in a double-blind randomized, crossover design. CMJ metrics were assessed before, post, and 2 h, 4 h, and 6 h after each condition while readiness was assessed at 6 h. Results: Perceived physical, mental performance capability and activation balance were higher at 6 h after Priming and PrimingCaf conditions. Immediate reductions in jump height (5.45 to 6.25%; p < .046), concentric peak velocity (2.40 to 2.59%; p < .041) and reactive strength index-modified (RSImod) (9.06 to 9.23% p < .051) after Priming and PrimingCaf were observed, being recovered at 2 h (p > .99). Concentric impulse was restored in PrimingCaf (p > .754; d = -0.03 to-0.08) despite lower concentric mean force/BM (p < .662; d = -0.18 to -0.26) as concentric duration was increased (p > .513; d = 0.15 to 0.21). Individual analysis revealed that some participants benefit from both strategies as they showed increases in jump height over the smallest worthwhile change while others did not. Conclusions: Psychological readiness was increased after both priming conditions at 6 h; however, it seems necessary to consider individual changes to achieve the positive effects of the priming or the priming in combination with caffeine on jumping outcomes.

Assessment of Peak Physical Demands in Elite Women Soccer Players: Can Contextual Variables Play a Role?

Aim: To describe and compare the peak physical demands through the worst-case scenario method (WCS), according to different rolling average (RA) time epochs (i.e. 1 min, 3 min, and 5 min) and contextual variables in women soccer players. Methods: Using an observational-comparative study design, an elite women soccer team from the Spanish 1st league division was monitored during 27 matches. Nine WCS-dependent variables were assessed, including total distance (TD), high-speed running distance (HSR), sprint distance (SP), acceleration, and deceleration distance at different intensities by players position (i.e., central defenders [CD], wide defenders [WD], central midfielders [CM], wide midfielders [WM], forwards [F]), match half, location, and match outcome. Results: The 1-min RA showed the lowest variability (CV = 9.8-65.8%) for all nine dependent variables. The WD presented the highest TD (168 ± 15.71 m/min). Differences between positions were observed for: CM

Nasal Symptoms in Asthmatic Patients under Treatment with Anti-IL-5 Monoclonal Antibodies. A Real-Life Cohort Study.

Currently, some monoclonal antibodies (mAbs) are being studied for chronic rhinosinusitis with nasal polyps (CRSwNP). Three anti-IL-5 mAb: mepolizumab, reslizumab and benralizumab, have been tested through randomized clinical trials. In this real-life study, we aimed to describe the nasal effects of a cohort of asthmatic adults treated with anti-IL-5 mAb. Methods: We carried out an observational study in adults (≥18 years) on anti-IL-5 mAb treatment. Variables included ACT and SNOT−22 questionnaires, nasal polyps score, blood total IgE levels and blood eosinophil count. Results: Overall, 38 participants were included in the study; 19 patients received mepolizumab, 17 were treated with benralizumab and 2 patients were given reslizumab. There was a statistically significant difference in the ACT and SNOT−22 scores before and after mAb treatment. ACT score increased from 11.05 to 21.5 after treatment (p < 0.001). SNOT−22 decreased from 57 to 37.3 after treatment (p = 0.004). No statistically significant differences between mAb groups were observed regarding the ACT or the SNOT−22 (p = 0.775) response (p = 0.775). In addition, 60.53% of patients obtained a minimal clinically important difference (MCID) in SNOT−22. Conclusions: A significant clinical response based on SNOT−22 score evolution after anti-IL-5 mAb treatment was observed. This study also demonstrated that blood eosinophil count, rather than serum total IgE levels, is the best predictor of asthma symptom improvement, which was assessed through the ACT and SNOT−22 questionnaires.

Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso / Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document

Introducción: La reconstrucción de base de cráneo constituye uno de los mayores retos de la cirugía endoscópica endonasal expandida. Existen multitud de injertos y colgajos de origen endonasal que han demostrado su utilidad en el control de complicaciones como las fístulas de LCR, entre otras. Se hace necesaria la revisión y el análisis de los recursos endonasales y su uso en cirugía endoscópica endonasal expandida.ObjetivosDocumento de consenso sobre el uso de los distintos injertos y colgajos de origen endonasal y su uso en cirugía endoscópica endonasal expandida.Material y métodosRevisión bibliográfica sobre los injertos libres y colgajos vascularizados de origen endonasal más relevantes. Análisis mediante el método Delphi, sobre el uso de los distintos recursos endonasales para la reparación endoscópica de defectos de base de cráneo.ResultadosSe obtuvieron dos resultados. 1) Una selección de los colgajos e injertos de origen endonasal más representativos, describiendo origen, superficie e indicaciones, a partir de una revisión bibliográfica. 2) Un documento de consenso, utilizando la metodología Delphi, con las consideraciones generales (2), recomendaciones (10) y limitaciones (6) sobre el uso de los distintos colgajos e injertos de origen endonasal.ConclusionesPresentamos el primer documento de consenso en el campo de la cirugía endoscópica endonasal utilizando el método Delphi como herramienta de trabajo. Se destaca la utilidad del colgajo nasoseptal junto con el resto de colgajos e injertos de origen endonasal para la cirugía reconstructiva de base de cráneo. (AU)

Introduction: Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes.ObjectivesThe target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery.Material and methodsLiterature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects.ResultsWe obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts.ConclusionsWe present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction. (AU)

Analysis of Prevalence and Predictive Factors of Long-Lasting Olfactory and Gustatory Dysfunction in COVID-19 Patients.

BACKGROUND: Although smell and taste disorders are highly prevalent symptoms of COVID-19 infection, the predictive factors leading to long-lasting chemosensory dysfunction are still poorly understood. METHODS: 102 out of 421 (24.2%) mildly symptomatic COVID-19 patients completed a second questionnaire about the evolution of their symptoms one year after the infection using visual analog scales (VAS). A subgroup of 69 patients also underwent psychophysical evaluation of olfactory function through UPSIT. RESULTS: The prevalence of chemosensory dysfunction decreased from 82.4% to 45.1% after 12 months, with 46.1% of patients reporting a complete recovery. Patients older than 40 years (OR = 0.20; 95% CI: [0.07, 0.56]) and with a duration of loss of smell longer than four weeks saw a lower odds ratio for recovery (OR = 0.27; 95% CI: [0.10, 0.76]). In addition, 28 patients (35.9%) reported suffering from parosmia, which was associated with moderate to severe taste dysfunction at the baseline (OR = 7.80; 95% CI: [1.70, 35.8]). Among the 69 subjects who underwent the UPSIT, 57 (82.6%) presented some degree of smell dysfunction, showing a moderate correlation with self-reported VAS (r = -0.36, p = 0.0027). CONCLUSION: A clinically relevant number of subjects reported persistent chemosensory dysfunction and parosmia one year after COVID-19 infection, with a moderate correlation with psychophysical olfactory tests.

Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document.

INTRODUCTION: Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES: The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS: Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS: We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS: We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Acute caffeine supplementation enhances several aspects of shot put performance in trained athletes.

The aim of this investigation was to determine the effect of a moderate dose of caffeine (3 mg/kg/b.m.) on muscular power and strength and shot put performance in trained athletes. METHODS: Thirteen shot putters (eight men and five women) participated in a double-blind, placebo-controlled, randomized experiment. In two different trials, participants ingested either 3 mg/kg/b.m. of caffeine or a placebo. Forty-five min after substance ingestion, athletes performed a handgrip dynamometry test, a countermovement jump (CMJ), a squat jump (SJ), and a maximum-velocity push-up. The athletes also performed three types of throws: a backwards throw, a standing shot put and a complete shot put. RESULTS: In comparison with the placebo, caffeine ingestion increased CMJ height (32.25 ± 7.26 vs. 33.83 ± 7.72 cm, respectively; effect size (ES) = 0.82, p = 0.012; +5.0%;) and SJ height (29.93 ± 7.88 vs. 31.40 ± 7.16 cm; ES = 0.63, p = 0.042; +6.4%) and distance in the standing shot put (10.27 ± 1.77 m vs. 10.55 ± 1.94 m; ES = 0.87, p = 0.009; +2.6%). However, caffeine ingestion did not increase strength in the handgrip test, power in the ballistic push-up, or distance in the backwards throw (all p > 0.05). Shot put performance changed from 11.24 ± 2.54 to 11.35 ± . 2.57 m (ES = 0.33, p = 0.26; +1.0%), although the difference did not reach statistically significant differences. Caffeine ingestion did not increase the prevalence of side effects (nervousness, gastrointestinal problems, activeness, irritability, muscular pain, headache, and diuresis) in comparison with the placebo (p > 0.05). CONCLUSION: In summary, caffeine ingestion with a dose equivalent to 3 mg/kg/b.m. elicited moderate improvements in several aspects of physical performance in trained shot putters but with a small effect on distance in a complete shot put.

Caffeine increases exercise intensity and energy expenditure but does not modify substrate oxidation during 1 h of self-paced cycling.

AIM: Oral caffeine intake has been deemed as an effective supplementation strategy to enhance fat oxidation during aerobic exercise with a steady-state intensity. However, in real exercise scenarios, individuals habitually train with autoregulation of exercise intensity. This study aimed to analyze the effect of oral caffeine intake during self-paced cycling on autoregulated exercise intensity and substrate oxidation. METHODS: Fifteen young and healthy participants (11 men and 4 women) participated in a double-blind, randomized, cross-over investigation. Each participant took part in 2 experimental days consisting of pedaling for 1 h with a self-selected wattage. Participants were told that they had to exercise at a moderate intensity to maximize fat oxidation. On one occasion participants ingested 3 mg/kg of caffeine and on the other occasion ingested a placebo. Energy expenditure, fat oxidation rate, and carbohydrate oxidation rate were continuously measured during exercise by indirect calorimetry. RESULTS: In comparison to the placebo, caffeine intake increased the self-selected wattage (on average, 105 ± 44 vs 117 ± 45 W, respectively, P < 0.001) which represented a higher total work during the cycling session (377 ± 157 vs 422 ± 160 kJ, P < 0.001). Caffeine increased total energy expenditure (543 ± 161 vs 587 ± 155 kcal, P = 0.042) but it did not affect total fat oxidation (24.7 ± 12.2 vs 22.9 ± 11.5 g, P = 0.509) or total carbohydrate oxidation (87.4 ± 22.4 vs 97.8 ± 32.3 g, P = 0.101). CONCLUSION: Acute caffeine ingestion before an exercise session with an individual's freedom to regulate intensity induces a higher self-selected exercise intensity and total work. The selection of a higher exercise intensity augments total energy expenditure but eliminates the effect of caffeine on substrate oxidation during exercise.

Effects of 3 mg/kg Body Mass of Caffeine on the Performance of Jiu-Jitsu Elite Athletes.

The effects of caffeine were investigated in judo, boxing, taekwondo and Brazilian jiu-jitsu. However, this substance was never investigated regarding traditional jiu-jitsu. Therefore, the aim of this research was to analyze the effects of caffeine in the Special Judo Fitness Test (SJFT) and technical variables during combat in traditional jiu-jitsu elite athletes. Methods: Twenty-two young professionals of traditional jiu-jitsu, 11 men and 11 women (age = 22 ± 4 (18−33) years, body mass = 66.6 ± 10.8 (46.2−86.1) kg, height = 1.70 ± 0.9 (1.55−1.85) m) with 15 ± 7 years of experience in traditional jiu-jitsu, participated in a double-blind, counterbalanced, crossover study. In two different conditions, the traditional jiu-jitsu athletes ingested 3 mg/kg body mass of caffeine or a placebo. After 60 min, they performed the SJFT test to measure throwing performance, and subsequently, combat to analyze offensive and defensive hitting techniques. Results: Caffeine had a main effect on the number of throws during the SJFT test (P < 0.01). In addition, it was effective in sets 2 (13 ± 2 vs. 14 ± 2; p = 0.01) and 3 (12 ± 2 vs. 13 ± 1; p = 0.03). There was also a main effect during the test on heart rate when caffeine was ingested (F = 12.48, p < 0.01). The effects of caffeine were similar compared to the placebo condition regarding performance during combat both in offensive and defensive fighting variables Conclusions: the pre-exercise ingestion of 3 mg/kg body mass of caffeine increased performance in the SJFT test, decreased fatigue perception, and increased power and endurance perception in professionally traditional jiu-jitsu athletes. However, it did not seem to improve offensive and defensive technical actions during combat.

Effects of beetroot juice intake on repeated performance of competitive swimmers.

Background: Beetroot juice is a sport supplement with a high level of evidence on the physical performance enhancement. However, in swimming, there is no clear data about the effects of beetroot juice on performance. Objective: To investigate whether an acute intake of beetroot juice (BJ) improves the performance of competitive swimmers in a repeated maximum swimming effort. Method: Thirteen national-level swimmers (six females and seven males), participated in this randomized, double-blind crossover study. In two different trials, swimmers ingested a 70-mL placebo shot (.04 mmol NO3 -; PLA) or a 70-mL Beet-It shot (6.4 mmol of NO3 -beet juice [BJ]) 3 h before undergoing a 6 × 100-m front-crawl maximal effort test with 7 min rest between each 100 m. Results: Overall, 100-m times showed no difference between the BJ and PLA groups (p = .364), although a possibly shorter time was observed for BJ in the last repetition (p = .104; mean difference [MD] = -.99 s, mean-based inference [MBI] = 49/51/0). Participants in the BJ condition showed a possibly lower rate of perceived exertion in the first (p = .242, MD = -.85, MBI = 70/28/2) and second repetitions (p = .165, MD = 1.15, MBI = 83/16/1), whereas Total Quality Recovery scale scores were likely higher in the first (p = .110, MD = 1.15, MBI = 83/16/1) and third (p = .082, MD = -.77, MBI = 70/29/1) repetitions compared with those in the PLA group. Blood lactate concentration [La+] levels showed no differences between groups in any of the repetitions (p > .05, unclear), and we observed an increase in 100-m times for both BJ and PLA (BJ: p = .014, MD = -1.51 s; PLA: p = .029, MD = -1.57 s) after the fifth repetition. Conclusion: No clear differences in performance were observed in a 6 × 100-m repeated sprint test by competitive swimmers when supplementing (or not) with BJ. However, there was a trend toward a better recovery between efforts and a better tolerance of fatigue when swimmers ingested BJ.

Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. / Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso.

INTRODUCTION: Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES: The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS: Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS: We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS: We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Usefulness of endonasal mucoplasty in the surgical treatment of chronic rhinosinusitis with nasal polyps. Prospective study.

Chronic Rhinosinusitis with Nasal Polyps (CRScPN) is a disease with great impact on health. The surgical option using endoscopic nasosinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRScPN. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal oedema in patients with CRScPN in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRScPN in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRScPN. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), in the case group was significantly better than in the control group, (45.9 [19.6]-26.6 [16.05], P = 0.027). The endoscopic improvement in healing and mucosal oedema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both pits, but without reaching significance (P = 0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic breast resections.

Utilidad de la mucoplastia endonasal en el tratamiento quirúrgico de la rinosinusitis crónica con pólipos nasales. Estudio prospectivo / Usefulness of endonasal mucoplasty in the surgical treatment of chronic rhinosinusitis with nasal polyps. Prospective study

La rinosinusitis crónica con pólipos nasales (RSCcPN) es una enfermedad con gran impacto sobre la salud. La opción quirúrgica mediante cirugía endoscópica nasosinusal es la alternativa terapéutica cuando no se alcanza el control de la enfermedad con el tratamiento médico. Los abordajes endoscópicos extensos se están postulando como posible mejor opción de tratamiento quirúrgico en ciertos fenotipos de RSCcPN. La mucoplastia endonasal asociada a estos abordajes ha demostrado ser una técnica complementaria que mejora tanto la cicatrización como el edema mucoso a corto plazo en pacientes con RSCcPN. El objetivo de nuestro estudio ha consistido en analizar los resultados de las mucoplastia endonasal asociada a una etmoidoesfenoidotomía completa más sinusotomía frontal de grado III en el tratamiento de RSCcPN a medio plazo. Para ello se realizó un estudio prospectivo de casos y controles (10/10) en pacientes con RSCcPN. En el grupo de casos se asoció a la cirugía una mucoplastia endonasal en la fosa nasal izquierda y en el grupo control no. La evaluación de la calidad de vida al año de la intervención quirúrgica, medida mediante la diferencia de medias de SNOT-22 (media [DE]), en el grupo de casos fue significativamente mejor que en el grupo control (45,9 [19,6]-26,6 [16,05]; p=0,027). La mejoría endoscópica de la cicatrización y del edema mucoso, medida mediante la escala de Lund-Kennedy modificada, mostró mejorías relevantes al comparar ambas fosas, pero sin alcanzar la significación (p=0,29). La mucoplastia endonasal favorece la cicatrización a corto plazo, lo que mejora la calidad de vida a medio plazo (un año) de los pacientes tratados con resecciones extensas endoscópicas de los senos. (AU)

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with great impact on health. The surgical option using endoscopic sinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRSwNP. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal edema in patients with CRSwNP in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRSwNP in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRSwNP. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), was significantly better in the case group than in the control group (45.9 [19.6]-26.6 [16.05] P=0.027). The endoscopic improvement in healing and mucosal edema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both nostrils, but without reaching significance (P=0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic mucosal resections. (AU)